RSVP of Durham County
HOURS AND MILEAGE LOG
Sponsored by Durham Technical Community College and the Corporation for National and Community Service
1637 Lawson St. Durham, NC 27703 voice: 919-536-7247 fax: 919-536-7283 email: rsvp@durhamtech.edu
Volunteer Name (Print) _____________________________________Last 4 digits SS#__________ Month __________, 20____
Mailing Address ________________________________________________________ City/Zip _________________________
Station Name _______________________________________________ Auto Insurance Information on File? ☐ Yes ☐ No
TOTALS
For Office Use Only: Account Code:____________________________________ Amount:______________
Account Code:____________________________________ Amount:______________
Total:______________
IMPORTANT! Please obtain your volunteer station supervisor’s original signature before submitting.
VOLUNTEER: By signing below, I certify that this statement and the amount claimed are true, correct and complete to the best of my knowledge. I
certify that I possessed a valid driver’s license and that liability insurance in the minimum amount required by law was in force at the time of this
travel.
STATION SUPERVISOR: By signing below, I certify that to the best of my knowledge this claim is correct and true.
___________________________________________________ __________________________
RSVP Volunteer Signature Date
___________________________________________________ __________________________
Station Supervisor Signature Date
___________________________________________________ __________________________
RSVP Staff Signature Date
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
